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Move from Traditional Change Management
to Agile Methodology
Session #139, February 13, 2019
Sherri Hess, MS-IS, BSN, RN-BC, FHIMSS Chief Nursing Informatics Officer,
Banner Health
Jean Palazzetti, MSN, MBA, RN, Sr Dir Nursing Informatics, Banner Health
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Sherri Hess, MS-IS, BSN, RN-BC, FHIMSS
Jean Palazzetti, MSN, MBA, RN, HCM
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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Pre-Agile Landscape at Banner Health
Why agile
Agile principles
How to implement agile
Benefits of agile
Data to support
Retrospective
Agenda
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Explain the importance of moving from traditional
change management to Agile methodology
Explain how to implement a governance model to
support an agile, rapid methodology
Describe the importance of a data driven
approach, using analytics to lead design
Identify three principles in Agile methodology
Describe three benefits of Agile methodology
Learning Objectives
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Banner Health System
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Dare To Dream
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Polling Question
How long from request for an enhancement to implementation?
1. 0-3 months 3. 6-9 months
2. 3-6 months 4. 9-12 months
How many requests are in your backlog?
1. Under 100 3. 300-600
2. 100-300 4. Way too many to count
Are your end users satisfied with your enhancement process?
1. Delighted by the process
2. Saddened, needs improvement
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Significant growth
New venues of care delivery
Essential Clinical Data Set
Clinician satisfaction
Patient Obsessed culture - Sofia
Minimal data used to drive
changes/enhancements
Landscape For Change
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Enhancement process long
Unclear on decision making process
Metrics unclear
Large meetings poor decision making
Education was “one size fits all”
Why Agile?
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Waterfall Change Management
Converted large academic
system
Enhancement request was
complex
Large backlog of requests
Adoption low
Communication was
challenging
Rarely went back to
measure success
Pre Agile
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Which Landed Us Here
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18,000 Nurses
Done
Done
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Agile Principles
Satisfy customer-early and continuous delivery
Welcome change
Individuals and interactions over processes and
tools
Working software over comprehensive
documentation
Customer collaboration over contract negotiation
Respond to change over following plan
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Training
Assemble the teams
Start-DO SOMETHING
Scrum meetings
Grooming sessions
Retrospectives
How To Implement
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Benefits Of Agile
Whole team & stakeholders (SMEs) at the
table real time
Simplicity
Reflection & Fine Tuning
Team size
Work broken down into manageable units
Focus on quality
Frequent delivery
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Capabilities Completed
Average:
23 Capabilities
per Iteration
Total Counts:
362 Complete
17 Ready
86 In Progress
299 Backlog
1
2 2 2
3
2
3
2
7
9
5
4
8
1
2
1
1 1
1
2
2
1
6
1
2
11 5
10
8
5 5
12
6
8
9
10
15
24
1
1
4
3
2 2
2
3
3
3
1 1
2
6
1
2
6
1
6
5
1
6
6
3
1
1
2
3
1
4
3
2
5
8
4
10
9
7
7
7
8
7
3
0
5
10
15
20
25
30
35
40
45
Iteration
01
Iteration
02
Iteration
03
Iteration
04
Iteration
05
Iteration
06
Iteration
07
Iteration
08
Iteration
09
Iteration
10
Iteration
11
Iteration
12
Iteration
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Iteration
14
Iteration
15
Iteration
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Ambulatory Consumer/Portal Cross Venue Operations
Hospital Based Medicine Lab Meds Process
Procedural Specialty Medicine
Break/Fix
Only
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Orders to Scheduling
Decreased the
turn around time
from procedure
order to actual
scheduling time
by 36.4%
Equated to 2
days and 4 hour
reduction
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Baseline
25.40% of the orders were scheduled within
the first 24 hour of the order being placed
10.31% of orders were scheduled between
24-48 hours
35.71% of orders were scheduled within the
first 48 hours
Comparison
43.12% of the orders were scheduled within
the first 24 hours of the order being placed
11.22% of orders were scheduled between
24-48 hours
54.34% of orders were scheduled within the
first 48 hours
Increased the amount of orders
scheduled within 48 hours by 52.2%
52.2%
Baseline: February 2018
Go Live: September 5, 2018
Comparison: October 2018
Excludes: Orders with a turn around time greater than 28 days
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Prevented 534,532 mCDS alerts for all users
6.4+ million projected prevented mCDS alerts over 12
months for all users
Data Source: Millennium
Baseline: 3/1/18 3/31/18
Comparison: 8/8/18 9/8/18
534,532
prevented mCDS
alerts over 1
month for all users
6.4+ million
projected prevented
mCDS alerts over 12
months for all users
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ED Physician Efficiency Metrics
Adjusted Time in EMR per patient reduced from 19 min 42 seconds to
11 min 59 secs. Total of nearly 8 minutes!
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Interdisciplinary team
Triad approach
Feedback Loop
Dedicate resources
Support
Education
IT
Informatics
Aligning Support To The Work
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Banner Comprehensive Approach
Agile
Governance
ECD
Clinically
Driven
Data
Utilization
Efficiency
Analysis
ECD/Model
Subjective
Survey
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What went well
Hit the ground running
Teams engaged and Leaders
supportive
Stakeholders on board
Large amount of work done in a short
amount of time
Clinicians eager for optimization
Post Agile Retrospective
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Lessons Learned
Not all pieces have to be done in one
iteration
Review usage and efficiency analytics
before and after
Take time to address poor adoption
Put all projects in one place
Don’t bombard one group with too many
changes
May be too agile
Retrospective, cont’d
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Are you ready to adopt agile?
1. Bring it on!
2. No Way!
Polling Question
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Sherri Hess MS-IS, BSN, RN-BC, FHIMSS
Chief Nursing Informatics Officer
602-747-7288 | Sherri.Hess@bannerhealth.com
Jean Palazzetti, MSN, MBA, RN, HCM
Sr Director Nursing Informatics
602-747-7538 | Jean.Palazzetti@bannerhealth.com
Questions